Editorial: HMOs will pay for new treatments

For anyone who questions whether health maintenance organizations have had a debilitating effect on the quality of medical care, consider that HMOs have been unyielding in their refusal to pay for members who want to enroll in clinical trials that evaluate new drugs and medical procedures. In many of these instances, patients have had cancer or other serious diseases and have wanted to participate in these promising new treatments, but HMOs refused, arguing that they were experimental.

But in a dramatic turnaround, managed-care companies appear to be on the verge of agreeing to help pay for these trials. This could result in thousands of patients getting treatments that have been refused in the past, the New York Times reported Tuesday. While the details haven't been formally announced, the Times said that the American Association of Health Plans, an industry trade group, has reached an agreement with the National Institutes of Health that HMOs will try to boost the number of patients who take part in clinical trials.

Since almost half of Americans are in some type of health plan, restrictions on treatment can be harmful in two ways. First, the patient loses because he doesn't have access to the latest in medical technologies or treatments that have yet to be approved for wide use. Second, medical researchers lose since they are unable to see if these new treatments work in real-world settings. In a recent report to Congress, the National Cancer Institute contended that the resistance of HMOs paying for clinical trials became "a serious barrier to progress" in cancer research.

Regarding the cost of the clinical trials, it is important to note that the chief medical officer at United Healthcare, which has 13 million members in 32 states, doesn't believe that they will be more costly than the conventional care a patient receives. So the red herring of additional costs being incurred should be a nonissue.

It is shameful that years have passed without patients getting the chance to get involved in these clinical trials. In some situations patients have had to sue HMOs to get them to pay for these new treatments.

Maybe HMOs are finally realizing that their cold-hearted policies aren't earning them any favors. It is sad, though, that it requires public pressure for them to do the right thing. As Congress and state legislatures, including Nevada, consider putting in place more restrictions on HMOs, expect a flurry of feel-good proposals from HMOs in an effort to stave off legislation. While paying for clinical trials is a good step, legislators shouldn't be fooled into thinking that this minimizes the need for oversight elsewhere.

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